To investigate the outcome of intravitreal bevacizumab (IVB) compared with laser photocoagulation in type I retinopathy of prematurity (ROP).
Case records of 54 consecutive very low birth weight ...(VLBW) infants with type I ROP (posterior ROP, n=33; peripheral zone II, n=21) who were treated either with IVB (n=37) or laser photocoagulation (n=17) between 2011 and 2015 were retrospectively evaluated.
Patients with posterior ROP displayed significantly faster regression of active ROP within 12 days (range 9-15 days) if treated with IVB compared with laser photocoagulation, where active ROP regressed within 57 days (range 28-63 days) (p>0.001). No difference was observed in peripheral zone II.Five of seven patients (12%) who developed a recurrence in both eyes after IVB required additional laser photocoagulation within a mean of 12.7 weeks (11.3-15.6 weeks) after the previous treatment. After laser photocoagulation one patient with posterior ROP developed macular dragging and another patient developed a temporary exudative retinal detachment in both eyes. 12 months after treatment the spherical equivalent was not statistically significant different between IVB and laser photocoagulation in posterior ROP patients. However, IVB lead to a significant lower spherical equivalent in infants with posterior ROP (+0.37 dioptres, range -0.5 to +1.88 dioptres) compared with peripheral zone II (+3.0 dioptres range +2.0 to +4.0 dioptres, p<0.001).
IVB leads to faster regression of active ROP in infants with posterior ROP compared with laser photocoagulation. Spherical equivalent after 12 months was comparable in those treated with IVB and laser photocoagulation, but it was significantly lower in posterior ROP than in peripheral zone II.
To measure the peripapillary retinal nerve fiber layer (RNFL) thickness in normal children.
Observational cross-sectional study.
Ninety-two eyes of 92 normal children ages 4 to 17 years presenting to ...the Ophthalmology Clinic at the Harkness Eye Institute, Department of Ophthalmology, Columbia University.
Retinal nerve fiber layer thickness was measured with optical coherence tomography (OCT). Patient cooperation and signal strength of the OCT scans were assessed. Optic disc photographs were evaluated by a glaucoma specialist in a masked fashion. Eyes with abnormal optic discs were excluded. One eye of each subject was randomly selected for statistical analysis. The effect of several factors on RNFL thickness was investigated statistically.
Retinal nerve fiber layer thickness.
Ninety-one percent of the study subjects were Hispanic; 8%, African American; and 1%, Caucasian. Optical coherence tomography measurements were obtained in 117 of 121 (96.7%) subjects, and disc photographs were available for 92 of them. Mean age (+/-standard deviation SD) was 9.7+/-2.7 years. Mean global RNFL thickness (+/-SD) was 107.0+/-11.1 microm (range, 78.1-134.6). The RNFL was thickest inferiorly (136.9+/-16.9 microm) and superiorly (135.4+/-19.3 microm), thinner nasally (83.0+/-18.0 microm), and thinnest temporally (72.5+/-13.4 microm). In univariate regression analysis, age (P = 0.013) and refraction (P<0.001) had a significant effect on RNFL thickness; age had a significant effect on refraction (P<0.001). When controlling for refraction, age no longer had a significant effect.
Optical coherence tomography can be used to measure RNFL thickness in children. Refraction had an effect on RNFL thickness. In normal children, variation in RNFL thickness is large. The normative data provided by this study may assist in identifying changes in RNFL thickness in children.
Retinol‐binding protein (RBP) is the sole specific transport protein for retinol (vitamin A) in the circulation, and its single known function is to deliver retinol to tissues. Within tissues, ...retinol is activated to retinoic acid, which binds to nuclear receptors to regulate transcription of >300 diverse target genes. In the eye, retinol is also activated to 11‐cis‐retinal, the visual chromophore. We generated RBP knockout mice (RBP−/−) by gene targeting. These mice have several phenotypes. Although viable and fertile, they have reduced blood retinol levels and markedly impaired retinal function during the first months of life. The impairment is not due to developmental retinal defect. Given a vitamin A‐sufficient diet, the RBP−/− mice acquire normal vision by 5 months of age even though blood retinol levels remain low. Deprived of dietary vitamin A, vision remains abnormal and blood retinol declines to undetectable levels. Another striking phenotype of the mutant mice is their abnormal retinol metabolism. The RBP−/− mice can acquire hepatic retinol stores, but these cannot be mobilized. Thus, their vitamin A status is extremely tenuous and dependent on a regular vitamin A intake. Unlike wild‐type mice, serum retinol levels in adult RBP−/− animals become undetectable after only a week on a vitamin A‐deficient diet and their retinal function rapidly deteriorates. Thus RBP is needed for normal vision in young animals and for retinol mobilization in times of insufficient dietary intake, but is otherwise dispensable for the delivery of retinol to tissues.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Intermittent exotropia (IXT) is a congenital form of divergent strabismus. Its incidence is estimated to be 32 per 100 000. Most often, IXT is first noted in early childhood when intermittently ...manifest outward deviation of the eyes is seen. Patients with IXT can control the deviation and keep the eyes aligned; this ability can be measured with "control scores". Complications such as amblyopia and loss of binocular functions are rare but should be looked for and need to be avoided. IXT can have a negative impact on quality of life. Conservative treatment includes the correction of refractive errors, (alternating) occlusion, over-minus lenses and orthoptic exercises. By injecting an extraocular muscle with botulinum toxin (to weaken its function) or with bupivacaine (to strengthen its function), IXT can be treated pharmacologically. Diagnostic occlusion and prism adaptation are strategies to uncover the true (largest) angle. Eye muscle surgery aims at eliminating the condition, but recurrences are common. The literature on large, randomized prospective trials for IXT is scarce. However, there are trials underway in the United Kingdom and in North America to better understand the natural course of IXT and to determine the most appropriate therapeutic approach.
Hintergrund:
Die endokrine Orbitopathie (EO) ist eine entzündliche Erkrankung der Augenhöhle mit einer Inzidenz von etwa 1:1000. Meist mit einer Überfunktion der Schilddrüse assoziiert, kommt die EO ...auch bei Normal- und Unterfunktion vor.
Der M. rectus inferior der M. rectus medialis sind die am häufigsten betroffenen Augenmuskeln, doch können selten auch die schrägen betroffen sein.
Methoden:
Verschiedene chirurgische Methoden zur Behandlung eines Schielens bei EO werden vorgestellt. Zwei Ziele stehen im Vordergrund: 1) Erreichen einer Parallelstellung, 2) Verbesserung der Motilität. Wir untersuchten zudem in einer retrospektiven Fallserie unsere Ergebnisse mit M. obliquus inferior Rücklagerung bei Pseudostrabismus sursoadductorius im Rahmen der EO.
Ergebnisse:
Die Therapie des Schielens bei EO ist zunächst konservativ (Behandlung der Grunderkrankung, anti-inflammatorische Therapie). Bei schwereren Fällen steht die systemische – insbesondere die intravenöse – Therapie mit Kortikosteroiden im Vordergrund. Für Biologika (wie Infliximab und Rituximab) konnte bisher keine verlässliche Wirksamkeit nachgewiesen werden, bei z.T. dramatischen Nebenwirkungen. Optische Behandlungen (z.B. Prismen) können bei Doppelbildern helfen. Die Schielbehandlung ist zumeist chirurgisch. Als Operationen sind verschiedene Verfahren (Rücklagerung, Sehnenverlängerung) beschrieben. Bei komplexen Fällen sind oft mehrere Operationen notwendig, um ein zufriedenstellendes Ergebnis zu erreichen. Horizontales Schielen lässt sich leichter korrigieren als vertikales, hier kommt es postoperativ aufgrund der zyklorotatorischen Funktion der vertikalen Muskeln z.T. zu verkippten Doppelbildern. Bei Pseudostrabismus sursoadductorius im Rahmen einer EO kann eine einseitige Rücklagerung des M. obliquus inferior durchgeführt werden. Wir fanden eine Reduktion des vertikale Schielwinkels von 9,8 ± 2,9 (Mittel ± Standardabweichung) Prismendioptrien (PD) auf 1,3 ± 1,5 PD im Geradeausblick. Postoperativ fand sich bei keinem Patienten ein manifestes Höhenschielen mehr.
Schlussfolgerungen:
Schielen bei EO ist oft komplex und inkomitant. Die chirurgische Behandlung muss individuell geplant werden. Sie sollte erst durchgeführt werden, wenn keine aktive Entzündung mehr vorliegt. Die Rücklagerung des M. obliquus inferior als Folgeoperation ist eine wirksame Operation in der Behandlung des Pseudostrabismus sursoadductorius bei EO.
Ultra-violet (UV) and middle wavelength sensitive (M) cone responses were identified in the ERG of normal and
Rpe65 −/− mice using chromatic flashes and selective chromatic adaptation. In normal ...mice, the UV-cone response was as large as, or larger, in the presence of a bright yellow adapting light than it is in the presence of a dim white light. The M-cone response became undetectable in the presence of the yellow adapting light. Yellow adapting light initially reduced the UV response, but it recovered in 8–10 min. The M-cone response did not recover. UV-cone responses were undetectable in
Rpe65 −/− mice. The M-cone response of young
Rpe65 −/− mice was almost as large as in normal mice. A yellow adapting light only diminished this M-cone response. With age, the M-cone response further decreased in
Rpe −/− mice. We show a pronounced loss of UV-cone function in
Rpe65 −/− mice, which may be related to a defect UV-cones share with rods. The M-cone function is also affected already in young
Rpe65 −/− mice. The transient effect of a yellow adapting light on the UV-cone response of normal mice is suggested to be neural, because it disappears during maintained light adaptation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In this case series and review of the literature, we describe 2 cases of abducens neuromyotonia (ANM) as the presenting sign of an intracranial tumor (meningioma). Review of the literature suggests ...that the pathophysiology of ocular neuromyotonia is incompletely understood. Most patients with ANM have a history of radiation therapy. The diagnosis of ANM is made on the basis of clinical findings and can be supported by electrophysiological studies. A complete neurologic examination is mandatory for patients with ANM. Treatment consists of eliminating the underlying cause; carbamazepine is effective in alleviating the symptoms of ANM. Neuroimaging should be performed if patients with ANM lack the typical history of radiation therapy, as ANM may be the presenting sign of an intracranial mass.
A 2-month-old boy presented with an irregular left pupil. Over the course of 3 months, progressive pupil ovalization, corectopia, and ballooning of the thinned superior iris tissue caused obstruction ...of the visual axis. Because of concern for deprivational amblyopia, a sectoral pupilloplasty and sphincterotomies were performed, restoring pupil shape and clearing the visual axis. On postoperative examinations, the pupil remained round, the visual axis clear, and visual acuity of the left eye improved. Findings and clinical course suggested the diagnosis of idiopathic tractional corectopia, a rare congenital disorder of unknown cause that may lead to isolated unilateral progressive corectopia and visual axis obstruction. Patients should receive regular follow-up examinations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Thyroid-related orbitopathy is a form of orbital inflammation associated with thyroid dysfunction, developing in many patients with Graves disease. Fibrosis of the inferior rectus muscle can lead to ...restricted elevation and vertical ocular misalignment, which may be improved by recessing this muscle. In some patients, vertical misalignment persists after surgical weakening of one or more vertical rectus muscles. In this case series, unilateral inferior oblique recession as a secondary procedure after inferior rectus recession reduced hypertropia in primary gaze from 9Δ ± 3Δ to 1.3Δ ± 1.5Δ (mean ± standard deviation) and largest hypertropia in side gaze from 18.3 ± 2.1Δ to 3.3Δ ± 1.5Δ . Postoperatively, all 3 patients were diplopia free in primary and downgaze.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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